Change of Occupancy Form

Landlords and property managers can file a Change of Occupancy Report here.
Submit within 10 days of a new tenant, a change of tenancy, or a tenant move-out. Use one form per rental unit.

Download the paper form (PDF)

"*" indicates required fields

Submit within 10 days of a new tenant, a change of tenancy, or a tenant move-out. Reporting is required even when bills are mailed to the owner. One form per rental unit.

SSN and EIN privacy notice: We do not collect Social Security numbers (SSNs) or Employer Identification Numbers (EINs) through this online form. Please submit any required SSN or EIN by mail or in person to the Village of Minerva, 209 N. Market St., Minerva, OH 44657. Do not include an SSN or EIN in any field on this form.

Report type*

Move-in

Move-out

Occupant change

Select every type that applies.

Date submitted*

Rental property

Property street address*

Apartment / unit number

Property owner / authorized agent

Owner legal name / business name*

Owner mailing address*

Street Address Address Line 2 City State ZIP Code

Owner phone

Owner email*

Authorized agent / property manager

Agent phone

Agent email

Tenant / occupancy information

List every tenant age 18 or older. If there are more than four adults, email the extra names and dates to finance@ci.minerva.oh.us.

Adult tenant 1 name*

Adult tenant 1 move-in date

Adult tenant 1 move-out date

Adult tenant 1 phone

Adult tenant 2 name

Adult tenant 2 move-in date

Adult tenant 2 move-out date

Adult tenant 2 phone

Adult tenant 3 name

Adult tenant 3 move-in date

Adult tenant 3 move-out date

Adult tenant 3 phone

Adult tenant 4 name

Adult tenant 4 move-in date

Adult tenant 4 move-out date

Adult tenant 4 phone

Current total occupants*

Please enter a number from 0 to 99.

Current occupants age 18+*

Please enter a number from 0 to 99.

Date lease signed

Departing tenant forwarding address

Identify the tenant if more than one person is moving out.

Water and sewer billing

All water and sewer accounts and bills must be in the property owner's name. Bills may be mailed to the tenant using: Owner Name, c/o Tenant Name.

Mail bills to*

Mail bills to owner

Mail bills to tenant, in care of

In care of (tenant name)

Billing mailing address*

Street Address Address Line 2 City State ZIP Code

Signature

Owner / agent signature*

Type your legal name.

Signature date*

Under Ordinance 36-86, unpaid utility balances ultimately remain the property owner's responsibility.

Reporting rule: Ordinance 8-14. Failure to report may result in penalties up to $100 for the first offense and up to $150 for second and subsequent offenses. Keep a copy of your submission. Phone reports are not accepted.